Anyone have successful VBA2C in the hospital by due date?

[Snow Cherries]

My Dr. is very supportive of my trying a VBA2C in the hospital so long as I don't go overdates. I've been mentally preparing for another repeat c-section for this baby because I was sure/assumed that it would be such a challenge to even try for a VBA2C. I just didn't feel up to the challenge (and likely disappointment) of standing my ground against hospital regulations, disapproving dr.s, etc. I know that makes me sound like a total wimp. But I was certain that there were regulations in place that would prevent the use of induction methods and I had no real hope of going into labor on my own. I've had 2 C-sections, and at least know what to expect with that route so I decided to forego the fight and focus on having a happy and healthy (last) pregnancy and to do all I could to help my body prepare and recover from the c-section.

But a few weeks ago my Dr. (I have Kaiser, by the way) threw me a curveball and asked me if I'd decided on VBAC or repeat c-section. I honestly thought he'd lost his mind because I thought it was all settled that I would be having a repeat c-section. He went on a long rant about how I'm a person, not an object, it's my choice and even if others (hospital admin etc.) might prefer that I choose a repeat c-section, no one can force me to do anything I don't want to. He also said emphatically that he always feels that a nice vaginal delivery is preferable to a nice c-section delivery no matter the circumstances. So I've been thinking/worrying/freaking out for a couple of weeks and trying to wrap my head around the idea of even trying a VBAC. At my appointment yesterday we decided that if I go into labor on my own before my due date I will try a VBAC. I even signed a form that said I consent to VBAC and understand the risks. He said that if on my due date I'm not in labor, but show some progress in preparing for labor (effacement or dialation), he isn't opposed to using just a little bit of pitocin to see if it will bump me into labor. If not, then I'll have a c-section, no worries.

I feel pretty happy with this plan except for the fact that I can't imagine going into labor before my due date. No on in my family does that and with my last baby, my cervix was closed up tight still at 39 weeks. With that birth, my midwife was going to try to induce me using the foley balloon method, but she couldn't even get the little tiny tube in my cervix because it was so closed up still. So while I have this new possibility on the horizon, I'm thinking odds are that I'll still have a c-section.

I know everyone is different and there's no way to really predice birth and labor, but I thought I'd look for a little inspiration here. Does anyone have any thoughts on my situation? Anyone had a successful VBA2C in the hospital before going past their due date?

[claudi81]

my hospital had the policy that if you do not go into labor on your own by 41 weeks they do a repeat c-section, they do not like to induce and that is it...of course I did not go into labor by 41 weeks and since I developed hypertension and could not withstand any more pressure I gave into the RCS, however I can tell you running on a clock when you want VBAC is not easy, every day your due date gets closer you get more stressed out about it...I wish I would not have had that pressure, and honestly I wish I would not have given in to the RCS at 41 weeks eventhough I had some reasons bp wise. You will wonder what if I waited 1-2 days longer ...what if are a constant thing and I am willing to do whatever this time to have a VBAC so I do not have any more what ifs!

It is your decision and you can definetly do whatever you feel most comfortable with..but expecting to go into labor by your due date will lower your chances unneccesarly (unless you have healthyissues) 50% go into labor by 41 weeks and 1 day the rest goes even longer, concidering that is an eyeopener for me now

Good luck

[libertymom]

I had a successful vab2c (after twins and 1). I knew I was doing a vba2c from the day I found out I was pregant so I did a lot of research. From what I found out, almost no one has uterine rupture unless given pitocin. If I were you, I wouldn't do the pitocin. If you really want to vba2c, they can't force you to have a c-section, even at 42 weeks.

[Xerxella]

I'll be looking at a VBA2C for my next pg and I understand the "not wanting to fail and not wanting to fight." There's nothing you can really do at this point. (By the way, I think I'm in love with your doc. He really seems to be on a woman's side.) So, just run with it.

I might try to say, wow, huh, funny thing, I looked back at my calander and it looks like my LMP was actually a week later than we thought. Huh, how about that? This doc may just say, great, lets adjust your dates or he might say, well lets keep with whatever dates the US came up with. It's worth a shot.

So, that being said, I think I'd try all the "natural" methods I could find to induce labor starting at 37 weeks. (I tried everything from chiro, accupuncture to castor oil to beat a 40 week deadline and all that worked was the membrane sweep. And, I had lied about my LMP date and my DD was actually 41 weeks.) I don't mean to discourage you, that's just my experience. I'd love to hear from someone who "made it."

[Snow Cherries]

Thanks for the replies. I know that being on a clock may give me additional and unnecessary anxiety which probably won't be conducive to allowing labor to start naturally and peacefully. That fact is one that made me sort of give up on the idea of a vbac in the beginning. Xerxella - "not wanting to fail, not wanting fight" is exactly how I've felt throughout this pregnancy.

The idea of having a successful, no (or very low) intervention vbac is so appealing to me, it's like a dream. I'm just kind of pessimistic as to whether it's really all that likely. I'm trying to be hopeful though. I haven't even thought about the vaginal birth process this pregnancy, so now I'm also nervous about the very idea of vaginal delivery. C-section almost seems easier to me now since that's at least what I'm used to, despite the fact that the idea of another one terrifies me.

Something that is confusing/interesting to me is that different providers have such different opinions of what is and isn't safe. I was really surprised that my doctor said he would be willing to try a little bit of pitocin to help me along, because I too had heard/read that rupture is so much more likely with pitocin. I told him that with my last baby, my then-midwife wanted to try a foley/balloon induction and he very adamantly stated that he would NEVER use that method of induction on a woman with a c-section scar. He said that the balloon actually goes into the bottom of the uterus and puts pressure right at or just below the area of the scar and he feels that to put physical pressure at the area of the scar and trying to stretch it out when it's not ready would be very dangerous in his opinion. Whereas, my old midwife insisted that it was very safe and the best option in a vbac situation.

So I have had two medical/birth professionals give me totally opposing information. They've both attended thousands of births and have years and years of experience, but they obviously think differently. Who's opinion do I trust? I can read all the books etc. that I want, but I don't have a medical degree, I haven't participated in thousands of births and seen the outcomes of various interventions. But it kind of freaked me out yesterday when my doctor expressed this view because 2 years ago, I fully trusted my then-midwife and was planning to willingly go ahead with a foley/balloon induction. If my cervix hadn't been closed up so tight, it's what I would have done and I felt confident in that decision. It scares me to think that it could have been a very bad decision. And I researched it! I found so many sources that said it was a good induction method for vbac. So is my current doctor nuts? Has new information come out in the past two years showing it to be dangerous?

I used to believe so strongly that birth was a natural process. I had such confidence in birth and now I see it as a series of potential dangers no matter which course one chooses.

Still, I will plan for a vbac and try to get my head on straight in the next few weeks (I'm almost 34 weeks right now) so that I can do everything I can to promote a great vbac outcome. But if I end up with a c-section, I don't think I'll be devastated, since I've spent the majority of this pregnancy resigned to the idea of one.

[kltroy]

You have some legit concerns and confusion about whose opinion to trust here - one experienced doctor versus the next. Here's the thing-- in theory, all doctors strive to practice "evidence based medicine' (or at least, they should). The reality is that doctors have different comfort levels and have had varying expereinces that influence their own decisions about how to implement medical practice. ...to the point where some of them may not realize it but they're not practicing evidence based medicine any more. Put yourself in a doc's shoes for a moment and imagine that you had a bad VBAC experience -- mom came in, you were supportive, there was a catastrophic UR and the baby died. This is always a possibility (albeit a small one - roughly 1/1000) but it can be quite awful for everyone involved and you can bet that it sticks hard in the doctor's mind. You wonder what you could have done to change the outcome. If you had only induced/not induced/monitored more closely/whatever, would that have saved the baby? So then, as a doctor, you may change your practice as a result of this sort of event, based on the sincere desire to never lose another baby in this context. Anyway, this is where the practice differences arise. So what do you do about it and whom do you trust? You trust the large meta-analyses and large randomized controlled trials that are out there. The reason that you trust these is because it gives you a sense of what the risks are of various things happening. It doesn't tell you what will happen during YOUR labor and YOUR birth, but it gives you a basis upon which you can make an informed decision.

Based on my read of the medical literature, the risks of UR for VBA2C are about 0.9%, versus 0.7% for VBA1C. Beyond that slight increase, there's nothing that is substantially different about your body and your birth compared to a VBA1C. One of my OB friends tells me that despite the fact that she's very pro-VBAC and recognizes that the risks of VBA2C aren't much greater than regular VBAC, it is simply beyond her comfort level to attend such births, so she refers them to a colleague who does high risk pregnancies. You can't really fault her for practicing this way - as a doc, she has to feel comfortable with the care she is providing people too.

In any case, if you are happy with your present arrangement, do everything you can to go into labor naturally. I would do weekly membrane sweeps starting at 37 weeks. I'd have lots of sex (at least 2x/week) starting around 36 weeks. And if an induction looks favorable when you get to 40 weeks and you feel that is the right choice you can always give it a shot. That said, if the baby looks absolutely fine at 40 weeks, is there a particular reason that you feel it's time to get the baby out? As many have commented, the average length for a pregnancy is around 41 weeks, and there is no medical evidence that suggests your baby will be safer having been born at 40 weeks versus 41. Furthermore, the risk of rupture does not go up between 40 and 41 weeks. So another option if you get to 40 weeks and there's nothing going on would be to give it another 3-4 days and see how you're feeling and whether you go into labor on your own. My own VBAC was at 41+2, and I had a 42 week "deadline" before we really got serious about getting the baby out, but I understand your concern about having a deadline and wondering whether your body will kick into gear in time. It can be a little stressful.

However you decide to handle it, I wish you a peaceful birth and the best of luck! (a little luck never hurts )

[roadfamily6now]

What is post date? Technically it is after 42 weeks. So considering that 95% of women have their baby by 42 weeks, you should be good to go!

[womenswisdom]

I am not aware of any research showing that going past 40 weeks increases your risk of rupture at all. Have you asked your doctor about that? Seems to me that Pitocin would be more risky than just waiting the extra week or whatever. Why would he want to take a known increase in rupture risk over watchful waiting with no known increase in rupture risk? And I have never, ever read anything about a foley induction being dangerous for a vbac. The foley bulb puts pressure on the cervix, which is going to be dilating anyway if you are having a vbac. I can't even envision how a foley bulb would put pressure on the scar. It's several inches away from your cervix by the time you get to term. Hmmm, mysterious...

[Snow Cherries]

Thank you for the thoughtful replies. To be honest, I'm not totally sure why the deadline is my due date. It was a long and kind of overwhelming conversation (since I really never envisioned having this option) and at the time I didn't think to question why he said anything about my due date being the deadline. It was just said in the course of conversation. I remember him specifically saying at one point that the safest time to perform a repeat c-section was between 39-40 weeks and at the time I just absorbed that info and didn't question it. But he didn't really say it like it was the bottom line and he wouldn't be comfortable going any longer.

His opinion about the foley method was that the balloon actually has to go into the uterus in order to be inflated and so it puts pressure on the lower part of the uterus near the scar. To be honest, the way my midwife described the method to me, I believed that it was inflated in the cervix and that it never even entered that actual uterus. ?? I don't know. The whole thing was/is new to me. I've never known anyone who has had that method used on them and had never even heard of it before my midwife suggested it.

kltroy - thank you for your post. I understand what you're saying and it makes sense. I wish these decisions were easier and that we all had crystal balls.

I'm so overwhelmed by the divide between the typical birth community (and society in general) and the natural birth community. Everyone has their statistics and anecdotal evidence and determining who's experience and advice to rely on when I'm hormonal and exhausted from pregnancy is really difficult! I read the numbers and it makes so much sense to have a vbac, but then I think that that 0.9% chance isn't just a chance of something like a 4th degree tear, but something with the potential to be much more devastating. Do I want to knowingly do anything with a 0.2% increased chance of being truly catastrophic?

My doctor gave me a big, long pep talk about the fact that every single choice we make in life has some associated risk. Am I going to stop driving because I have a certain statistical chance of being involved in a fatal car accident? No. But for some reason, this choice seems so much more deliberate (even though it really isn't) and against the grain of what a lot of people "think" is safe and that makes it so hard to feel confident in this choice.

I probably don't sound very pro-vbac right now. I am! I'm just venting all my fears right now for some reason. It's one thing to believe something, it's another when it's me and my baby at stake. My confidence is in the gutter right now. I know I should be so thankful that I even have a doctor who is supportive of vba2c. From what I hear of other people's experiences, he's kind of a rare find.

I'm going to email my doctor to ask about the deadline issue. Maybe I'd feel less stressed in general if I didn't have to worry about "performing" by a certain date.

[Mom2M]

I had a VBA2C at 42 weeks. Originally, the practice I went to was discouraging the VBA2C and I had to argue for a chance at it. I brought in research papers I had printed out showing that the risk is extremely small compared to a regular VBAC and even compared to a regular vaginal delivery.
After we got to my due date, they were talking about when we needed to schedule a repeat c section.
I am always zero dilation till the day of delivery and was losing hope of VBA2C.
Anyway, we then decided to have the BPP every few days and if everything was good, wait a little longer. Finally they said ok, that's it we are scheduling but I asked for the weekend (42 weeks was a Sat) and I went into labor finally that Friday and delivered Sat morning.
Maybe you could talk about the BPP with your OB. It could make you feel secure also. One of the OB's in my practice was pro VBAC and afterward said, some women just go later than others, it's normal and that all my kids were late (and big).
Actually, I did read somewhere that the foley was not a good idea for inducing with a VBAC.
I'll look for it and post it later.
My VBA2C was amazing and empowering. It was so wonderful to just stand up and walk from the delivery room to a regular room!

[buckeyedoc]

My OB does a ton of VBACs and was fine with waiting to 42 weeks and then talking about a very light induction (but I delivered at 41+1). I know that one of the highly published VBAC "bigwig" OBs in my area does VBAmC and also will induce conservatively before going right to c/s. In your shoes, I would be very hesitant about using 40 weeks as a cut-off. I mean, I never delivered before 41 weeks. Can you stall if you reach your due date? Say you feel labor is close, or that c/s date doesn't work for you because of some scheduling conflict, etc.?

[roadfamily6now]

I have NEVER heard of a foley cathater being inserted in the uterus?? how do they get it in there? And why?

[buckeyedoc]

I've heard of the Foley being used to physically dilate the cervix to 3-4 cm as the first part of labor induction. Some medical professionals use it instead of prostaglandins, since those are contraindicated in VBACs. Then after the Foley, they may add a little pitocin if labor hasn't already gotten going. It's kind of a last resort at 42 weeks for most people.

[mrsberman]

Originally Posted by buckeyedoc 

I've heard of the Foley being used to physically dilate the cervix to 3-4 cm as the first part of labor induction. Some medical professionals use it instead of prostaglandins, since those are contraindicated in VBACs. Then after the Foley, they may add a little pitocin if labor hasn't already gotten going. It's kind of a last resort at 42 weeks for most people.

I've heard this as well. I have never heard of it being near your uterus (besides, it would have to get passed your cervix first, right?). I would do some research on your own, print it up to bring in and discuss with your dr. As far as pitocin goes. I've heard of women having successful VBAC inductions with extremely low doses and taking time to let it work before increasing the dose. Also, when your body starts contracting on its own, no more pitocin. This is my plan if I don't go into labor on my own and my MW is giving me until 42 weeks per hospital policy.

[Aandw]

Similar situation. Went 43 weeks with my first. No signs of labor--0. Worried that I would be post dated again. My ob was very supportive of vbac. Plan was to let me labor naturally by 42 weeks and then opt for c if nothing happens. At 38 weeks with no signs, began to get nervous and started with lots of sex. Water broke with no contractions, stayed at home for 2 days and initiated labor contractions with acupressure and black cohosh ( per doula). Contractions started -- delivered the next morning on my due date! I was really against induction (pitocin) but I ended up getting a low dose anyway as my labor slowed down. I think knowing what I know now if I would have been open to a slow slow pitocin start if I didn't show any signs like before.

Glad I at least tried this time around and trusted in my body. Recovery and experience was so much better-- Definitely recommend a doula for hospital births just to support you in that environment.. Even though my ob was supportive the obs on staff were less so.

Good luck!
Edited by Aandw - 11/16/10 at 7:07am